reduce the risk of those that cause permanent neurological disability or death. Given the low frequency of hemorrhage in functional neurosurgery, estimating its true incidence and identifying risk factors are challenging. We reviewed the hemorrhage rate in a consecutive series of patients undergoing functional neurosurgery via an image-guided approach at our institution. Evidence from the literature was also examined to determine the incidence and risk factors for hemorrhage as a complication of functional neurosurgery. Methods Our Consecutive Series of Image
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Ludvic Zrinzo, Thomas Foltynie, Patricia Limousin, and Marwan I. Hariz
Alexandre Boutet, Aaron Loh, Clement T. Chow, Alaa Taha, Gavin J. B. Elias, Clemens Neudorfer, Jurgen Germann, Michelle Paff, Ludvic Zrinzo, Alfonso Fasano, Suneil K. Kalia, Christopher J. Steele, David Mikulis, Walter Kucharczyk, and Andres M. Lozano
sequences, IR sequences have been found to be superior to routine T1W imaging ( Table 2 ). 62 , 69 Limitations As recently as 15 years ago, indirect targeting based on anatomical landmarks was the mainstay of preoperative surgical planning for most functional neurosurgery services. However, advances in MRI hardware and techniques have allowed direct targeting to become more accessible and clinically feasible. 25 Despite these improvements, there is limited consensus on the optimal MRI sequences for direct visualization of common DBS targets. While addressing
David Moser, Eyal Zadicario, Gilat Schiff, and Daniel Jeanmonod
T he therapeutic application of focused ultrasound in functional neurosurgery requires refined target reconstructions and precise targeting accuracy measurements within the millimeter domain. Because targets are in normal tissue, coordinates have to be established for each target on the basis of a stereotactic atlas of the human brain. Such an atlas uses internal landmarks to position a coordinate system onto the brain, allowing the placement of any desired target inside the brain. We use the Stereotactic Atlas of the Human Thalamus and Basal Ganglia , 1
Kaushik Das, Deborah L. Benzil, Richard L. Rovit, Raj Murali, and William T. Couldwell
in 1985. Fig. 1. Photograph of Irving S. Cooper, circa 1947. Courtesy of John Hogle, photographer. Foundations of Functional Neurosurgery At the time Cooper completed his neurosurgical training, surgical management of movement disorders focused on the treatment of Parkinson's disease. In the 1930s and 1940s there were a large number of patients with postencephalitic Parkinson's disease. 84 Medical therapy was limited, leaving surgery as the sole method available to alleviate the patients' distressing tremor. During this period, operations had
Constantin Tuleasca, Jean Régis, Elena Najdenovska, Tatiana Witjas, Nadine Girard, Jean-Philippe Thiran, Meritxell Bach Cuadra, Marc Levivier, and Dimitri Van De Ville
functional neurosurgery intervention. Whereas prior to LITT, brain activity showed robust interhemispheric functional connectivity, it was greatly reduced following callosotomy, with intrahemispheric functional connectivity being largely maintained. Understanding how brain rewiring after functional neurosurgery procedures impacts brain activity is essential for our understanding and for future developments in this extraordinary and continuously expanding field. In that context, rs-fMRI is particularly useful given its ability to map various functional networks
Alessandra Gorgulho, Antonio A. F. De Salles, Leonardo Frighetto, and Eric Behnke
age of this cohort was 59.6 years (range 3–87 years). Detailed demographic data obtained in these patients are presented in Table 1 . Fifty-seven patients underwent multiple surgical procedures as detailed in Table 2 . TABLE 1 Characteristics of 178 patients who underwent functional neurosurgery in which electrophysiological monitoring was performed * Characteristic Value patient age (yrs) mean 59.6 range 3–87 sex male 106 female 72 indication for surgery in 178 patients
Giuseppe R. Giammalva, Cesare Gagliardo, Rosario Maugeri, Massimo Midiri, and Domenico G. Iacopino
both ET and PD were successfully treated by VIM (ventral intermediate nucleus) thalamotomy in order to control medically refractory tremor. The excellent results obtained by the authors further support the effectiveness and safety of MRgFUS thalamotomy in the armamentarium of functional neurosurgery. In particular, only a small rate of mild and temporary adverse events was reported, and most of the patients experienced a sustained and significant improvement in their tremor. The effectiveness of transcranial (tc) MRgFUS in the treatment of movement disorders has been
Marc N. Gallay, David Moser, and Daniel Jeanmonod
T he first clinical study with incisionless transcranial MR-guided high-intensity focused ultrasound in the field of functional neurosurgery was published by Martin et al. in 2009. Since publication of this first trial, around 200 treatments have been reported. As each reported series has small numbers, 8 , 11 , 12 , 14 , 19 , 20 , 24 , 26 , 28 , 40 , 41 , 44 no procedure-related risk profile can be reliably inferred yet. To assess risks, one also needs an analysis of targeting accuracy, which is directly related to the risk of damage to neighboring structures
Jean Régis and Constantin Tuleasca
modern serious peer-reviewed series published in the last 16 years. In conclusion, this series of the Top 25 papers in JNS on GKS for trigeminal neuralgia bears witness to the fact that radiosurgery is an example of a true disruptive innovation in the field of functional neurosurgery and, specifically, in the neurosurgical management of trigeminal neuralgia. These articles demonstrate how greatly this innovation has changed neurosurgical practice in just a few years. Disclosure Professor Régis states that, although he receives no money personally, his
Taylor J. Abel, Timothy Walch, and Matthew A. Howard III
advances are now and will continue to be key procedures in the future of functional neurosurgery. What is little remembered, however, is that both procedures (i.e., extrapyramidal intervention for movement disorders and focused ultrasonic lesions of subcortical brain structures) have their origins in the pioneering work of one American neurosurgeon: Russell Meyers ( Fig. 1 ). FIG. 1. Portrait of Russell Meyers during his time as chairman of the Division of Neurosurgery at the SUI. Used with permission of the Department of Neurosurgery Archives, University of Iowa
